A study in this week’s issue of The Lancet suggests that human papillomavirus (HPV) testing should become the primary screening tool to rule out disease for women 30 and older, with Pap tests reserved for testing of women in their 20s and for further testing of women who test positive for HPV. The study reports results from the ATHENA trial, with its authors concluding: “HPV testing with separate HPV16 and HPV18 detection could provide an alternative, more sensitive, and efficient strategy for cervical cancer screening than do methods based solely on cytology.”

Does this mean the days of the Pap test are numbered? We asked Debbie Saslow, Ph.D., director of breast and gynecologic cancer for a comment.

Debbie Saslow, Ph.D.

“This is a large study done in the U.S. that shows that screening for cervical cancer with the HPV test alone detects more precancers than the Pap test alone, confirming other studies from Europe and Canada.

“Co-testing with HPV plus Pap is recommended by the American Cancer Society for women starting at age 30. According to this and other studies, co-testing appears to offer little benefit yet increased harms over the HPV test alone. However, there are still many questions to be answered before the ACS and other organizations within the U.S. and internationally consider screening with HPV alone.

“One important question is what to do when an HPV test used alone comes back positive. This study looked at two possible follow up strategies: use the Pap test to detect precancerous changes that would indicate the need for colposcopy, or use an additional test on the sample to look for the two HPV strains that cause most cervical cancers (HPV16 and 18). Follow-up data from this and other studies will help inform future screening guidelines.”

2 Responses to HPV Testing for Cervical Cancer

The great thing about HPV testing, and there is also a blood test, is you can simply test women at age 30 (assuming they wish to test) and if negative for high risk HPV and either in a monogamous relationship or no longer sexually active, could forget pap testing. These women are only tested into the future “in case” their risk profile changes….when testing carries a high risk of false positives and potentially harmful over-treatment, this decision should be the woman’s…if her risk profile changes in the future she could revisit the subject of further HPV or pap testing.
Ref: “Cervical cancer screening” in “Australian Doctor” July 2006 by Assoc Prof Margaret Davy and Dr Shorne
I have no idea why countries persist with pap testing women under 30 – it doesn’t change the tiny death rate in young women, but leads to awful over-detection and over-treatment. It is unethical IMO, to test those under 30 and any woman without informed consent. It shocks me that women are routinely coerced into elective cancer screening in the States, with reliable contraception DENIED to women who decline ELECTIVE screening. It is a shocking breach of patient rights and highly unethical. They don’t stop there either…American doctors also coerce women into extreme over-screening (annual testing) plus completely unhelpful and potentially harmful routine gyn and breast exams. “Women after birth control get unneeded pelvic exams” WSJ – “Is the routine pelvic exam obsolete” and comments by Dr Carolyn Westhoff.
Birth control has nothing to do with cancer screening.

Women who test positive for high risk HPV at age 30 (and only 5% are still infected by age 40) could be offered a program that provides some protection from false positives. The Finnish program calls for 5 to 7 tests, 5 yearly from age 30. They have the lowest rates of cc in the world and send the fewest women for colposcopy/biopsies. Some American women have had more than 40 pap tests by the time they reach 60 – just insane! Also, American doctors test women not yet sexually active from age 21 – that makes NO sense at all and risks the patients health for no benefit – this is highly questionable conduct for a doctor.
To hell with recommendations, politics and profits, the patients interests should come first…over-screening and inappropriate screening is harmful and unethical…and ALL cancer screening is elective and requires our informed consent. Men are not treated this way…I’ve never heard of men needing to see a doctor for condoms or Viagra and being coerced into a rectal exam…prostate cancer is common, cervical cancer is rare and was always rare….it seems paternalistic attitudes still control the profession.
We didn’t need to worry and harm so many women with this testing, it could have been done legally and ethically and spared huge numbers of women from the ordeal of over-detection and over-treatment. Some women are left with health issues after unnecessary treatments – infertility, cervical stenosis, cervical incompetence – miscarriages, premature babies, more c-sections etc
Women need to take control and take action against doctors who operate outside the law and ethical standards.
Dr Joel Sherman wrote, “Informed consent is missing from cervical screening”….some doctors are ethical and “get it”…we all know it’s wrong, but few are prepared to put their patients’ rights and health first.